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Mnemonics / quick learn > Gynae > Flashcards

Gynae Flashcards

1
Q

Vaginal discharge “fishy smell”

A

Bacterial Vaginosis
Retained tampon
Trichomonas

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2
Q

Extra Mx for STI? (sex)

A

SEX
Screen for other STIs
Education - e.g. condom use
Explain about partner education

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3
Q

When not to take COCP?

A 
Migraine w/ aura
VTE risk 
Fat - BMI>35
Smoke
Breast cancer - current/carrier of gene 
Breastfeeding <6weeks postpartum
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4
Q

Secondary ammenorhoea? (use to think about causes of anovulation aswell!)

A 
4Ps
Prolactinoma 
PCOS
Pregnant
Premature ovarian insufficiency

(others: stress, weight change, anorexia, Kallman’s)

Primary = failure by age of 16
Secondary = none for 6months in woman who previously could/12 months who had irregular
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5
Q

PCOS criteria (i.e. signs and symptoms). Hint - where did Villa win the european cup??

A

ROTTERDAM criteria -2outof3 required

SHOP 
string of pearls - on USS
hyperandrogenism - acne+hirsutism
Oligomenorrhea - irregular + heavy 
Prolactin normal
(also insulin resistance + obesity + subfertility)

[N.B you get high baseline LH + low FSH]

  • reduced oestrogen (due to FSH)
  • anovulation (high baseline = no LH surge)
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6
Q

PCOS ix?

A 
T4, TSH, Prolactin
Serum total + free testosterone
Fasting glucose
17-hydroxyprogesterone - for CAH
LH/FSH - LH:FSH ratio high - 3:1
USS - string of pearls
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7
Q

PCOS Mx?

A

1 - Lose weight, stop smoking
1 - CLOMIFENE / IVF (if want to be fertile)
2 - COC / Progesterone
3 - Metformin - ?insulin resistance/weightloss
4 - “Dianette” - acne+hirsutism
5 - Eflornithine cream/ laser/wax/shave - hirsutism

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8
Q

Endometriosis Ix + Mx?

A

Laparoscopy + Biopsy! - Chocolate cysts (ovaries) + fibroids/adhesions

Mx: - NOT IS ASYMPTOMATIC
Analgesia - para/nsaids
Meds - Stop ovulation - GnRH analogues / COCP/IUS..etc.
Surgery - ablation / excision

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9
Q

General Gynae Ix?

A 
Testosterone - free + total serum 
Oestrogen
TSH, T4
Prolactin 
LH / FSH
USS
PREGNANCY TEST
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10
Q

Subfertility definition? Primary/secondary?

A

Failure to conceive after 12months regular unprotected sex

Primary - female never conceived
Secondary - female conceived previously

Need 3 things - ovulation, healthy sperm, tubal patency

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11
Q

Sperm abnormlatities?

A

Azoospermia - no sperm
Oligospermia - little sperm
Teratozoospermia - abnormal
Asthenospermia - immotile

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12
Q

Assesment of subfertility - THINK THE 3 DOMAINS!!

A

Tubal patency - laparoscopy+cye / hysterosalpingogram

Sperm - count, motility, normal forms

Ovulation (i.e. axis!) -

  • Prolactin
  • FSH/LH
  • Oestrogen
  • Testosterone
  • Progesterone Day21 - confirms ovulation
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13
Q

Mx subfertility? THINK 3 DOMAINS!!

A

Weight loss, smoking, 2-3 times per week!

Anovulation

  • Clomifene / GnRH analogue
  • IVF, egg donation

Sperm

  • IUI (intrauterine insemination) - speed it up
  • IVF
  • ICSI (intracytoplasmic sperm injection) - single sperm

Tubal patency

  • tubal surgery
  • IVF
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14
Q

Miscarriage Mx (once stable)?

A

Wait + see
Misoprostol
ERPC
GIVE ANTI-D!!!!

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15
Q

Risk factors for Ectopic? (kate middleton’s sister)

Triad of symps - Pain, bleed, amenorrhoea!

A 
PIPPA
Previous ectopic 
IUD - (if got pregnant with it in)
Pelvic/tubal surgery 
PID
Assisted reproduction
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16
Q

Ectopic Ix? Mx?

A

TVUSS
hCG - suboptimal rise + fall between 0+48hrs
Examination - cervical motion tenderness

(FBC, group+save)

Methotrexate
surgical - Laparoscopy + Salpingectomy

17
Q

Heavy menstrual bleeding causes? Often 1st line Ix?

A

Dysfunctional uterine bleeding
Fibroids / Polyps
Adenomyosis

(PID, cancer, copper coil, IUS, hypothyroid, coagulopathy)

FBC!! –> then TVUS +/- hysteroscopy (+biopsy)

18
Q

Heavy menstrual bleeding managment?

A 
Non-hormonal (fertility sparing)
- tranexamic acid - anti-fibrinolytic
- NSAIDs
Hormonal 
- e.g. IUS, COC
- Oral progestogens in luteal phase (e.g. norethisterone)

Surgical:

  • myomectomy (fibroids) - fertility sparing
  • endometrial ablation, uterine artery embolization, hysterectomy
19
Q

3 mirena coil indications?

A

Contraception
Primary menorrhoea
Endometrial protection during HRT

20
Q

What are the triple swabs?

A

Endocervical - chlamydia
Endocervical - gonorrohoea
High vaginal - candida, trichomiasis, vaginosis

21
Q

Ovarian cancer RFs. General rule?

What protective?

A

Anything that ^number of ovulations

FH
BRCA (1>2)
Smoking
^Age
HRT

COCP + pregnancy = protective!

22
Q

Endometrial cancer RFs? General path?

A 
Endometrial hyperplasia due to:
Annovulation: 
-PCOS
-Premature ovarian insufficiency 
-prolactin^
Unopposed oestrogen:
Age
Obesity - adipocytes = stimulus to produce oestrogen
oestrogen only HRT
COCP
Tamoxifen
23
Q

Common types of HPV + associations? (nursery rhyme)

A

1 and 2, do up my shoe (veruccas)
11 and 6, warts on pricks (genital warts)
Please beware sweet little 16
Like number 18, she’s an oncogene (Cervical cancer)

24
Q

Mx for Cervical cancer? obvs classic surgery/chemo/radio - but specific surgeries - a bit different here.

Management of CIN?

A

Excision - v early stage - LLETZ / cone biopsy
Radical hysterectomy
Trachelectomy - removal of cervix + pelvic nodes w/ preservation of uterus body –> FERTILITY

CIN:

  • excision/destruction @ COLPOSCOPY
  • LLETZ
  • Cone biopsy
  • cryo/laser/cold coagulation
25
Q

Emergency contraception - 3 types. What are they - when can they be given, how do they work?

A

Levonorgestrel: - progesterone

  • delays LH surge - delays ovulation
  • within 72hours

Ulipristol: - progesterone receptor blocker

  • delays LH surge - delays ovulation
  • within 120hours

IUD: - MOST EFFECTIVE

  • prevents implantation + toxic to sperm
  • within 5 days
26
Q

Windows of starting contraception + protection

A

COCP - 7 days
POP - 2 days
IUD - immediate
IUS - 7days

27
Q

Missed pill rules. COCP? POP?

A

COCP
Missed 1 - take next one as planned - EC not needed
Missed 2+ - use condoms for 7 days plus:
-Week1 - EC (think as just come off pill free days)
-Week2 - No EC
-Week3- No EC, but miss pill free days

POP
Take missed pill - even if 2 in one day
Barrier methods for 48hours

28
Q

Bartholin cyst Bugs + Mx?

A

Anaerobes+Aerobes:
E.coli, staph, strep, proteus

Broad spec - metronidazole / cephalosporin
Incision + drainage –> then marsupialisation

29
Q

Chlamydia

Bug
RF
Symps
Ix
Mx
A

Gram -ve - chlamydia trachomatis (elementary + reticulate bodies)

Promiscuity + lack of protection

Dysuria, discharge, fever, post-coital bleeding, urethritis (males)

Vulvovaginal swab / endocervical swab
NAAT
first catch urine

Doxy + arithromicin

30
Q

Gonorrhoea

Bug
RF
Symps
Ix
Mx
A

Gram -ve diplococci - N.Gonorrhoea

promiscuity + lack of protection

Males - dysuria, discharge, perianal pain/bleeding
females - asymptomatic

Vuvlovaginal / endocervical swab
NAAT
First catch urine

IM ceftriaxone + oral azithromicin

31
Q

Syphillis

Bug
RF
Symps
Ix
Mx
A

V contagious - treponema pallidum

promiscuity + lack of protection

Papules + ulcers at site
latent period >2years - late CV + neuro signs

Treponema enzyme immunoassay (IgM - early infection)

BenPen

32
Q

PID

Bug
RF
Symps
Ix
Mx
A

Polymicrobial Gram-ve - Chlamydia, gonorrhoea, staph, strep, e.coli

promiscuity + lack of protection

Deep dyspareunia, discharge, fever, vaginal bleeding, abdo pain

Preg test
cervical swab + triple swabs 
USS
ESR/CRP
urinalysis
endometrial biopsy

Doxycylcine + metronidazole + ceftriaxone

33
Q

Candidiasis

Bug
RF
Symps
Ix
Mx
A

Fungal yeast infection - candida albicans

Common

WHITE COTTAGE CHEESE DISCHARGE
dyspareunia, dysuria
vulval pruritis / soreness

Clinical, high vaginal swab

Antifungal - fluconazole, clotrimazole
Creams/soaps/emollients

34
Q

Bacterial vaginosis

Bug
RF
Symps
Ix
Mx
A

Lactobacilli REPLACED - by overgrowth of bacteria

promiscuity + lack of protection
DOUCHING + BATHS

FISHY FOUL SMELL
white/grey discharge + dysuria

High vaginal swab
microscopy - CLUE CELLS
pH test (high pH) - +ve Whiff test

Metronidazole + clindamycin cream

35
Q

Trichomoniasis vaginalis

Bug
RF
Symps
Ix
Mx
A

FLAGELLATED PROTOZOA - trichoman vaginallis

promiscuity + lack of protection
BATHS + DOUCHING

FROTHY YELLOW / GREEN DISCHARGE
STRAWBERRY CERVIX
FOUL SMELLING
dysuria, itching

NAAT
High vaginal swab

Metronidazole

Mnemonics / quick learn (7 decks)

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